Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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The two commercially available taxanes (paclitaxel and docetaxel) are widely employed in standard oncologic practice. Toxicity of the agents includes bone marrow suppression (principally neutropenia), complete alopecia, and hypersensitivity reactions. ⋯ Docetaxel can be associated with the development of significant fluid retention (e.g., edema, ascites, pleural effusions), the incidence and severity of which appear to be limited by prophylactic treatment with corticosteroids both before and after each treatment. If patients are monitored closely (e.g., for hypersensitivity reactions, bone marrow suppression) the taxanes have a favorable side effect profile, and it is currently uncommon for treatment to be discontinued because of the development of excessive toxicity.
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Support Care Cancer · Feb 2003
ReviewNormal-release and controlled-release oxycodone: pharmacokinetics, pharmacodynamics, and controversy.
Oxycodone has become one of the most popular opioids in the United States. It is superior to morphine in oral absorption and bioavailability, and similar in terms of protein binding and lipophilicity. Gender more than age influences oxycodone elimination. ⋯ Deaths attributable to oxycodone are usually associated with polysubstance abuse in which oxycodone is combined with psychostimulants, other opioids, benzodiazepines or alcohol. Oxycodone's kappa receptor binding has little role in abuse or addiction. The cost of CR oxycodone is prohibitive for most American hospices.
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Fatigue, a common complaint of cancer patients, requires a multidisciplinary evaluation and treatment approach because of the multiple etiologies and contributing factors. Current treatments for fatigue include educating patients and caregivers about fatigue, applying etiology-specific treatments, utilizing nonpharmacologic interventions, and prescribing pharmacologic therapies. Often, an individualized treatment plan that includes several modalities may be developed. Presently, there is a lack of well-designed clinical trials to evaluate pharmacologic agents for the treatment of cancer-related fatigue.
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Support Care Cancer · Jan 2003
Curative and palliative aspects of regional chemotherapy in combination with surgery.
Many attempts have been made in the last two decades to improve the outcome of patients with advanced or metastasised solid tumours. In particular, combined-modality treatment strategies combining surgery with more localised therapies, e.g. radiotherapy, or systemic therapies such as chemotherapy have yielded promising data. The aim of regional chemotherapy is to improve locoregional cytostatic drug concentrations by achieving greater local efficacy and to diminish systemic side effects by reducing plasma drug levels. ⋯ Despite the high efficacy, the rate of side effects was low and acceptable. A steep increase in lung function parameters was observed in responding patients. This technique paves the way for a more effective induction therapy in advanced NSCLC, followed by resection and adjuvant radiotherapy of the mediastinum.
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Support Care Cancer · Jan 2003
Noninvasive ventilation: application to the cancer patient admitted in the intensive care unit.
The objective of this retrospective study of prospectively registered patients was to determine the usefulness and efficacy of noninvasive ventilation (NIV) in cancer patients admitted to the medical intensive care unit of an European cancer hospital for a medical complication, as reflected in discharges from the intensive care unit (ICU) and from hospital. The subjects were a total of 40 consecutive cancer patients (28 with solid tumours and 12 with haematological malignancies) who required immediate or delayed NIV. Variables relating to demographic parameters, severity scores, cancer characteristics, intensive care data and hospital discharge were recorded. ⋯ Among the 10 patients (25%) who required salvage invasive mechanical ventilation, only 1 was discharged from hospital. Sixty-four per cent of the solid tumour patients and 42% of those with haematological malignancies were discharged from the ICU and 50% and 25%, respectively, from the hospital. NIV thus appears to be an effective form of ventilatory support for cancer patients, including those with solid tumours.